Analyze the results of the bibliometric system and analysis of scientific publications (SIGAPS) in the Assistance publique–Hôpitaux de Paris (AP–HP) and compare the scientific production among the various surgical disciplines of the academic hospitals of Paris and define the place of urology.

Methods

The publications from 115 surgical departments between 2006 and 2008 were included. Only surgical departments were considered in the current study. The following data were taken into account: the hospital department of origin, the number of articles published, the number of first place, last places, the number of full-time unit, the SIGAPS score. Statistical analysis focused on the quality and on the quantity of published articles per surgeons and per department. There were eight academic departments of urology identified within the AP–HP.

Results

The database contained information for 115 surgical departments. The mean number of articles published by department was 42.89±27.34 (13.2 to 110.75). The mean number of publications per full-time surgeon was 6.7±2.59 (3.77 to 12.84), or a mean of 2.25±0.86 released by full-time and by year. The median score SIGAPS of surgery was 304 with a wide interval (122 to 903.5). Urology was the specialty with the highest median score compared to other surgical specialties. The department, which published the most, was the center 1, in comparison with the center 6 which was publishing the most in A/B ranking journals.

Conclusion

Urology was the absolute leader by far in terms of scientific publications in the AP-HP when compared to other surgical disciplines. The discipline is organized efficiently to juggle clinical work and research indicating a certain dynamism of the teams that invest there to fulfill the missions assigned to them in the University Hospital and the part of the autonomy of the universities.

Despite an aggressive initial treatment, only 60% of patients with T2-staged bladder tumours, 50% with T3a and 15% with T3b staged-tumours will be alive at 5 years. The purpose of this review is to clarify the potential role of chemotherapy in localised urothelial tumours, which has not been clearly defined.

Materials and methods

To address this question, we reviewed published randomized trials of chemotherapy in urothelial tumours of the bladder in both neoadjuvant and adjuvant settings from 1980 and 2010 and corresponding meta-analyses in PubMed.

Results

In the neoadjuvant setting, a meta-analysis of individual data from 3005 patients demonstrated an absolute survival benefit of 5.5% at 5 years. Despite these results, neoadjuvant chemotherapy is very rarely proposed in this indication. Comparative trials performed in the adjuvant setting have been limited by major methodological weaknesses, preventing definitive conclusions. In a meta-analysis based on individual data from 491 patients, a 25% reduction in death risk was observed for an absolute gain of 9% at 3 years.

Conclusion

In light of these data, chemotherapy should be offered early and proposed as a reasonable option for patients for tumours with extravesical extension or with nodal involvement detected postoperatively, neoadjuvant chemotherapy is the standard of care.

To assess the benefits of magnetic resonance imaging (MRI) in the dosimetric treatment planning for prostate radiotherapy.

Patients and methods

Ten consecutive patients have been enrolled. They were treated for a low risk prostate adenocarcinoma. A rigid superimposition was performed between MRI and scan slides obtained at time of virtual simulation, then prostate volume was delineated by four to five physicians, on TDM slides and on MRI/TDM superimposition. For each treatment plan, we assessed the impact of MRI in terms of planned treatment volume (PTV) position, individual variability of prostate delineation and doses delivered to the critical organs. The prescribed dose was 74Gy in 37 fractions to the PTV.

Results

PTV delineated on TDM (VTDM ) were 1.15 (SD 3.71) larger than volumes delineated on MRI. Prostate apex was 4.6mm (SD 2.87) lower on TDM than on MRI. Posterior limit of the prostate was in mean 4mm more posterior on TDM. The variability between physicians in terms of prostate delineation was lower using MRI. For apex, these variations were 6.8mm using TDM, versus 3.3mm using MRI. Mean rectal dose was 8 % lower with MRI, compared to delineation using TDM.

Conclusion

Superimposition TDM/MRI improves accuracy, decreases delineation variability, and allows to spare anterior part of the rectum from irradiation. It remains unknown whether this strategy translates into clinical benefit.

Estimate the feasibility and the results of the realization in consultation of a flexible videocystoscopy in blue light preceded by an instillation of Hexvix® (GE Healthcare) for the initial diagnosis or the surveillance of vesicals tumors (VT). The objective of this study was to compare the number of hurts seen in white light and in blue light, and to estimate in which percentage of case the use of the Hexvix® in consultation modified the care.

Patients and methods

Thirty consecutive patients (26 men and four women) were estimated prospectively by vesical videofibroscopy in blue light (Wolf’s PD videofibroscope) realized 1hour after an endovesical instillation of Hexvix®. All the examinations were realized in external consultation under local anesthetic by xylocaine gel: 23 (76.6%) patients within the framework of a surveillance of VT and seven (23.4%) for the diagnosis of a hematuria with normal echography. When a suspect hurt or a VT was discovered, the patients benefited from an endoscopic resection under anesthesia with new cystoscopy in blue light.

Results

Suspect hurts were revealed in 10 out of 30 patients, five in white and blue light, five in blue light only. Among the five only visible hurts in blue light, three were urothelial tumors (any pTa of bottom-rank, less of 5mm) and two non-specific hurts. No CIS’s hurt was revealed during this study. The fibroscopy in blue light allowed to diagnose invisible hurts in white light in three patients (10%) and has modified the care of five patients (16.7%). The duration of the cystoscopy was on average of 9.5minutes. The tolerance of the examination was good and no complication arose.

Conclusion

The use of the flexible videocystoscopy in blue light +Hexvix® has allowed to improve the rate of detection of VT. Except CIS’s hurts, this improvement was bound to the diagnosis of little aggressive small-sized VT. The indications must be specified by studies of bigger scale and a medical economic evaluation.

Surgically relevant obstruction after dextranomer/hyaluronic acid injection (Dx/Ha, Deflux®) for the treatment of vesicoureteral reflux (VUR) is rare with a 0.6% incidence. It occurs usually during the early postoperative period. We report here the case of a 9-year-old boy with a history of VUR who was previously treated with Deflux® and was referred more than 2 years later with acute flank pain (as he already did 2weeks after surgery with a spontaneous relief under medical treatment). Initial radiological investigations showed hydronephrosis caused by distal ureteral obstruction which required open surgery removal of the Dx/Ha and Cohen procedure. This is the second case of delayed symptomatic obstruction due to Dx/Ha reported in the literature.

in 1967 is a renal tumor often discovered in neonatal period and early childhood. It’s usually considered as a benign tumor with good prognostic for which nephrectomy is the reference treatment. But some cases of local recidives and metastatic sites had been described in the literature. For these reasons histologic analysis and quality of follow up are very important. In this observation we describe a neonatal kind of CMN and we discuss this pathology.

To assess the safety and effectiveness of percutaneous nephrolithotomy performed in the supine position. To investigate whether the change in operative technique, between prone and supine position, is easy.

Method

Thirty patients who underwent percutaneous nephrolithotomy, by one surgeon in one hospital, were studied retrospectively. The eight first cases were performed in prone position, and the following 22 patients were operated in supine position according to Valdivia’s operative technique. Data were analyzed with t -test. We considered P<0.05 as significant.

Results

Surgical complication rate, transfusion rate and fever rate were the same for both groups. Success rate was 72% in supine position group and 63% in prone position group (P>0.05). These results were comparable with the data of the literature. Only operative time was shorter in supine position group with significant statistical difference (P=0.02).

Conclusion

In our experience, percutaneous nephrolithotomy in the supine position was safe and efficient, and outcomes were similar to that in the prone position. Learning curve was easy and fast.

To study the effect of a preparation by erythropoietin before Onlay’s intervention on postoperative hematocrits and medium-term results of the surgery.

Patients and methods

Twenty-one patients were operated on by Onlay’s technique between 2001 January and 2008 September, after being treated by erythropoietin. Seven had a midshaft hypospadias, two a posterior hypospadias and 12 a penoscrotal hypospadias. All children were examinated four months after surgery to evaluate the surgical results.

Results

After the surgery, 18 children had an apical meatus (85.7%). Three had a balanopreputial meatus, two a stenosis of the meatus. Two children were reoperated on, one with the Duplay’s technique, the other for a meatostomy. No fistula, no necrosis of the preputial flap was observed. The preoperative hematocrit was measured at 41%, with an increase of 3.8% because of the preparation. Peroperative blood loss was evaluated at 6.6%. After surgery, 12 children had an hematocrit inferior than 35%, four an hematocrit inferior than 30%. No transfusion was needed.

Conclusion

Preparation by erythropoietin before severe hypospadias surgery seemed to have several advantages: a more elevated hematocrit after surgery than with an iron preparation alone, and a lower rate of postoperative complications, including fistulas and necrosis of the preputial flap.

Laparoscopic sacral colpopexy (LSCP) is one of the gold standard surgical treatment for the management of urogenital prolapse. Robot-assisted laparoscopic sacrocolpopexy (RALSCP) is an alternative surgical access which has been recently proposed. The aim of the current study was to report the functional results obtained after RALSCP.

Materiel and methods

A systematic review of the scientific literature was achieved in the Pubmed database, using the following keywords: robotic; robot; sacrocolpopexy; sacralcolpopexy. Clinical cases and series of less than five cases were spontaneously not selected herein.

Results

Overall, 12 series in published between September 2004 and September 2011 which included 350 female patients were selected. The mean age was 63 years old with a pelvic organ prolapse of stage 3 to 4 in the Baden Walker classification.

The mean operative time of the RALSCP was 207minutes with a conversion rate of 3,4% and an intraoperative complication rate of 4,6%. The mean length of hospital stay was 3 days and the perioperative complication rate of 7,1%. The success rate of the RALSCP was 97% and the vaginal erosion rate was 2,5% with a median follow-up of 13,5 months.

Conclusion

The mid-term functional results obtained after RALSCP were equivalent to those obtained with the LSCP approach. However, there is no prospective randomized comparison available between the two access so far. In addition, the experience with RALSCP remains limited due to the important cost that the robotic access generates.

Local preparation of rectum governs the possibly survenue of complications during transrectal ultrasound guided biopsies of prostate.

Objective

To determine the efficacy and acceptability of rectal preparation (Eductyl® suppository) in patients undergoing a transrectal prostate biopsy.

Patients and methods

From May to August 2005, eight urologists (Bel-Air Urological Center, Bordeaux) included 137 patients (mean age 66.4 years) with an indication of prostate biopsies. All patients were administrated prophylactic antibiotic therapy. They used Eductyl® effervescent suppositories for local preparation, the day before and/or the morning of the exam.

Results

Rectal vacuity was satisfactory or very satisfactory for 99% of patients. Introduction of probe and tracking of prostate were easy or very easy in 99% of cases. Eight days after the exam, only 35% of patients had suffered anal or rectal pain during a mean of 2 days. Most of patients recovered bowel function without requiring treatment and without any difficulty or pain. The bowel function recovery occurred the day of prostate biopsy and the day after for 28.4% and 62.2% of patients, respectively.

Conclusion

Urologists considered that the use of Eductyl® suppositories before prostate biopsies ensured a satisfactory rectal preparation and optimal conditions for the exam. Moreover, this preparation was well accepted by patients.